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Dementia and Cognitive Impairment: What are they and what should you do about them?

Dementia

Today an estimated 10 to 11 million Americans are believed to have one of the 47 identified forms of Dementia; that’s a new case every 36 seconds.1 Dementia is not a specific disease. It’s an overall term that describes having at least two of the four lobes of the brain affected in a way that impacts cognitive functions such as thinking, remembering, and reasoning. The affect ranges from barely detectable to highly debilitating.1 Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.3

Dementia is often incorrectly referred to as “senility” or “senile dementia,” which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging.3

Memory loss and other symptoms of dementia

While dementia symptoms may vary significantly, at least two of the following core mental functions must be drastically impaired to be considered dementia:

  • Memory
  • Communication and language
  • Ability to focus and pay attention
  • Reasoning and judgment
  • Visual perception

Those with dementia often have problems with their short-term memory, keeping track of personal items, paying bills, planning and preparing meals, remembering appointments or traveling away from the home.

Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. If you or a loved one is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. See a doctor soon to determine the cause. Professional evaluation may offer ways to slow the condition. And even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also provides time to plan for the future.

Causes

Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected.

The brain has four lobes, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular lobe are damaged, that lobe cannot carry out its functions normally.

Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is addressed:

  • Depression
  • Medication side effects
  • Excess use of alcohol
  • Thyroid problems
  • Vitamin deficiencies

Mild cognitive impairment (MCI)

Mild cognitive impairment, a reference to having minimal brain tissue loss, causes cognitive changes that may be noticed by the individuals experiencing them or to other people, but the persons affected can recover quickly from missteps and can function effectively. Approximately 15 to 20 percent of people age 65 or older have MCI.2

MCI Symptoms

Experts classify mild cognitive impairment based on the thinking skills affected:

  • With Mild Cognitive Impairment, a person may start to forget important information that he or she would previously have recalled easily, such as where they placed keys, appointments, conversations or recent events. This type of MCI is referred to as “amnestic MCI.”2
  • Thinking skills may also be affected such as the ability to judge a sequence of steps needed to complete a complex task, or visual perception. This type of MCI is referred to as “nonamnestic MCI.”2

Diagnosis of dementia

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it’s harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose “dementia” and not specify a type. If this occurs, it may be necessary to see a specialist such as a neurologist or geropsychologist.

Mild cognitive impairment is a “clinical” diagnosis representing a doctor’s best professional judgment about the reason for a person’s symptoms. If a physician has difficulty confirming a diagnosis of MCI or the cause of MCI, biomarker tests such as brain imaging and cerebrospinal fluid tests may be performed to determine if the individual has MCI due to Alzheimer’s.

What Kind of Doctors to See

Primary care doctor

If you notice changes in a loved one’s memory, thinking, or behavior, you should contact their primary care doctor. This doctor can help with the following:

  • Conduct an exam to see if any physical or mental issue has caused the problems.
  • Give a brief memory-screening test, such as the Abbreviated Mental Test Score. A score lower than 6 out of 10 suggests a need for further evaluation.
  • Provide essential medical history information needed for an accurate diagnosis.
  • Identify changes in the person’s memory and thinking others may miss.

Questions to ask upon getting a dementia diagnosis:

  • Why is the diagnosis dementia or Alzheimer’s?
  • What stage? What type?
  • What can we expect in the future?
  • Will the diagnosing doctor continue to provide treatment or provide a referral to a specialist?
  • Can any tests or imaging help clarify the diagnosis?
  • What medication may help?
  • Is there a treatment plan to delay progression?
  • Caregiving: What resources are available?

Alzeimer’s Disease Specialists

The primary care doctor can refer you to the right kind of specialists as needed for diagnosing and treating AD. These may include the following:

Geriatrician

Geriatricians are medical doctors who work with older adults. They know whether symptoms indicate a serious problem.

Geriatric psychiatrist

Geriatric psychiatrists specialize in mental and emotional problems of older adults. They can assess memory and thinking problems.

Geropsychologist

Geropsychologists specialize in the mental health needs of the elderly and their families. They can assess, intervene, and consult with you and other professionals regarding the care of a person with AD.

Neurologist

Neurologists are physicians who focus on abnormalities of the brain and central nervous system. They can conduct in-depth neurological examinations. Neurologists use brain scans, like CT and head MRI scans, to help make a diagnosis.

Neuropsychologist

Neuropsychologists generally perform tests of memory and thinking, as well as other tests, collectively referred to as neuropsychological testing. They can help determine a person’s specific impairments and how severe they are. Neuropsychologists may also correlate test results with the results of neurological tests such as CT and MRI scans to help make a diagnosis.

How The Legacy Senior Communities Can Help

At The Legacy at Home, all of our care team members are thoroughly screened and receive ongoing training to ensure they provide patients with quality care in a professional and respectful manner. Offering everything from medical care and physical/occupational/speech therapy in the home to companionship and caregiver respite visits, help with activities of daily living, escorts to doctor visits, and so much more, The Legacy at Home offers just the right amount of care for you or your loved one, whatever that level might be.

The Legacy Willow Bend in Plano (a Life Care community) offers specialized memory support housing, in a safe and secured setting, for seniors touched with memory loss, Alzheimer’s and other forms of dementia. We provide daily activities and other programming to support engagement and the lifestyle needs of our memory support residents, so every day can be a good day. The Legacy Midtown Park (a Rental Retirement Community opening in 2020 in Dallas) will also offer this same kind of specialized memory support housing.

If you’d like to learn more about The Legacy at Home, reach out to us and our knowledgeable team can answer your questions, address any concerns, and offer advice on a variety of topics. The Legacy at Home strives to be a resource not only for our clients, but for the community as well. Call our experts at (972) 244-7701 or visit click here to learn more.

 

Additional Resources:

If you or a loved one has been diagnosed with Alzheimer’s or another form of dementia, or you find yourself as a caregiver for someone who has, you are not alone. The following organizations offer additional tips and information you may find helpful:

 

Sources:

  1. Tam Cummings, Untangling Dementia, Alzheimer’s Disease, Diagnosis, Four A’s, Patients, Consulting, Speaking, Training – The Dementia Association. (n.d.). Retrieved July 31, 2018, from http://tamcummings.com/
  2. Mild Cognitive Impairment (MCI). (n.d.). Retrieved July 20, 2018, from https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment
  3. What Is Dementia? (n.d.). Retrieved July 20, 2018, from https://www.alz.org/alzheimers-dementia/what-is-dementia
  4. Doctors for Alzheimer’s: Specialists, Memory Clinics, and More. (n.d.). Retrieved July 20, 2018, from https://www.healthline.com/health/alzheimers-disease-doctors

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